Colonic Diverticular Disease

How would a colovesicular fistula present?

Air or stool would be present in the bladder --Pneumaturia

Diverticulitis: This can present with LLQ pain, fever, and leukocytosis. What disease looks very similar to this but is on the right side?

Appendicitis --Diverticulitis is known as 'left-sided appendicitis'

What is a diverticulum?

Blind pouch protruding from the GI tract that communicates with the lumen

Diverticulitis: A fecalith can block the diverticula. How does this lead to diverticulitis?

Block something --Infection develops behind the block

Diverticulitis: Colonoscopy cannot be done due to the risk of rupture. What can be done to confirm the diagnosis?

CT scan is the best test

Colonic Diverticulosis - Treatment: If there are repeated episodes of diverticulitis, how can this be treated definitively?

Colonic resection --Remove the affected area

Colonic Diverticulosis: Diverticula develop due to increased wall stress. What are some things that increase the wall stress? -Toilet? -Diet? -Age?

Constipation and straining Low-fiber diet Older age = more cumulative wall stress

Colonic Diverticulosis: How do the diverticula develop?

Develop due to wall stress

Colonic Diverticulosis: Where in the colonic wall do the diverticula develop?

Diverticula develop in the areas where the vasa recta perforate the muscularis externa (propria)

Colonic Diverticulosis - Complications: What can occur if the diverticula become inflamed?

Diverticulitis

What colonic diverticula true or false?

False diverticula --Mucosa and submucosa outpouches through the muscularis externa (propria

Diverticulitis: What causes this to develop?

Fecalith blocks the diverticula

What is a colovesicular fistula?

Fistula from the colon to the bladder

What will happen if an inflamed diverticulum ruptures and attaches to a nearby structure?

Fistula will develop

Colonic Diverticulosis - Complications: What can occur if the inflamed diverticula rupture and attach to a nearby structure?

Fistulas can develop

Colonic Diverticulosis - Treatment: What can be done to treat diverticulitis?

Give antibiotics

Colonic Diverticulosis: The vasa recta alongside the diverticula can bleed. How would this present clinically?

Hematochezia --Diverticulosis is the MCC of hematochezia

Colonic Diverticulosis - Treatment: What dietary changes can be made?

Increase fiber in diet

Colonic Diverticulosis: This develops in older people. Why does this occur?

More accumulated stress on the colonic wall over time --Leads to the diverticula

Colonic Diverticulosis: This is defined as many diverticula present in the colon. Where are the diverticula most common?

Most common in the sigmoid colon

Colonic Diverticulosis: How do diverticula most often present?

Most often asymptomatic --May present with vague abdominal discomfort

Diverticulitis: Diverticulosis is diagnosed with a colonoscopy. Can that be used here?

No --There is a risk of rupture with colonoscopy

Diverticulitis - Complications: The diverticulitis can perforate through the colon. What complications can this lead to? -Peritoneum? -Abscess? -After the bowels heal?

Peritonitis can develop Abscess formation Healing can occur with fibrosis -> Bowel stenosis

Where in the colon is the most common location for colonic diverticula?

Sigmoid colon

Colonic Diverticulosis: How can diverticulosis leads to bleeding?

The diverticula develop right alongside the vasa recta --The vasa recta can bleed into the lumen

Diverticulitis - Complications: What is the main complication that can occur?

The diverticulitis can perforate through the colon

Colonic Diverticulosis: The diverticula develop in areas where the vasa recta perforate the muscularis externa. Why do they develop here?

The perforating vasa recta make that area of the muscularis externa weak --Easier for the outpouchings to develop

Colonic Diverticulosis: What age group gets this?

This develops in older people --Present in 50% of people over 60

Diverticulitis: How is this treated?

Treated with antibiotics

Diverticulitis: How does this present? -Pain? -Normal response to infection? -WBCs?

LLQ pain --Most commonly in the sigmoid colon Fever Leukocytosis

Colonic Diverticulosis: What is this?

Many false diverticula present in the colon